Pure-O: The role of mental compulsions in OCD
Living with Obsessive-Compulsive Disorder (OCD) can be a distressing and isolating experience, often misunderstood by those unfamiliar with its complexities. Many clients come to me seeking help for what they refer to as “Pure-O,” believing that because their compulsions aren’t outwardly visible, they don’t exist at all. However, it’s important to note that Pure-O is not an official diagnosis but rather a term that has emerged online, coined by people with OCD to describe their experience with internal compulsions. Despite the absence of obvious behaviours, Pure-O isn’t as “pure” as the name suggests-there are still mental rituals and compulsions that accompany the intrusive thoughts.
In this post, we’ll explore what Pure-O entails and why it’s important to recognise these internal, hidden compulsions that often go unnoticed but are very real and keep the vicious cycle of doubt and anxiety going.
What is Pure-O?
Pure-O, short for “Purely Obsessional” OCD, is a term often used by individuals with OCD to describe a subtype where intrusive thoughts, images, or impulses (obsessions) are prominent, but without the visible compulsive behaviours that are typically associated with OCD.
While the term Pure-O has gained traction online, it is not recognised as a distinct diagnosis within clinical practice. However, the experiences it describes-severe anxiety driven by intrusive thoughts and reactive covert compulsions-are very real and often distressing for those affected.
The Misconception of Purity
The term “Pure-O” can be misleading. While it emphasises the absence of visible compulsions, it doesn’t mean that individuals aren’t engaging in compulsive behaviours at all. Instead, these compulsions are often covert and less observable, but just as disruptive.
Common covert compulsions in Pure-O include:
- Mental Rituals: Repeating certain phrases or prayers silently to neutralise intrusive thoughts.
- Mental Checking: Continuously reviewing past actions to ensure nothing harmful was done.
- Suppression: Trying to push away or ignore unwanted thoughts, which paradoxically can make them more persistent.
- Reassurance Seeking: Constantly seeking reassurance from oneself or others to alleviate anxiety caused by intrusive thoughts.
The Distinction Between Overt and Covert Compulsions
Overt compulsions are the external, visible behaviours commonly associated with OCD, such as handwashing, checking locks, or organising objects. These behaviours are easier to recognise and often serve as the stereotypical image of OCD.
Covert compulsions, on the other hand, are internal processes like mental rituals or avoidance strategies, making them harder to detect but equally taxing on the individual. The distinction between overt and covert compulsions is critical in understanding that, even though the compulsions may not be physically apparent, they are still a significant part of the individual’s OCD experience.
Why Pure-O Isn’t Truly “Pure”
In my work, I often explain to clients that while they may not be engaging in overt compulsions like handwashing or checking, the mental rituals they perform to cope with their intrusive thoughts are still compulsions. These covert behaviours can be just as distressing and disruptive to daily life as external compulsions. Because of their hidden nature, covert compulsions can sometimes lead to delayed recognition or misunderstandings, making it harder for individuals to seek help or understand why they feel so overwhelmed.
Seeking Help and Treatment
Recognising that Pure-O involves compulsions-whether overt or covert-is crucial for effective treatment. Cognitive Behavioural Therapy (CBT), particularly Exposure and Response Prevention (ERP), has proven to be highly effective in managing OCD symptoms, including those associated with Pure-O. Therapy can help individuals identify and modify the thought patterns and behaviours that contribute to their anxiety, leading to improved quality of life.
Conclusion
Pure-O is not a formal diagnosis but rather a term used to describe a specific OCD experience where mental compulsions overshadow more obvious, external behaviours. Despite this, the internal rituals and coping mechanisms are very much present and distressing. Understanding the true nature of Pure-O and the distinction between overt and covert compulsions is essential for those affected and their loved ones to foster empathy, support, and effective treatment strategies.
If you or someone you know is struggling with intrusive thoughts or OCD, seeking professional help can make a significant difference. I work with individuals facing these challenges, and together, we can create a path toward standing up to your OCD bully and regaining control of your life. Feel free to get in touch with me here if you’d like support or have any questions-I’m here to help.
